背景:非传染性疾病(NCDs)与撒哈拉以南非洲地区发病率和死亡率的高负担和上升有关。包括尼日利亚。糖尿病(DM)是全球NCD相关死亡的主要原因之一,是尼日利亚最重要的公共卫生问题。作为国家政策的一部分,尼日利亚承诺实施世界卫生组织(世卫组织)初级保健基本非传染性疾病干预措施一揽子计划。实施干预需要基本要素的可用性,包括指导方针,训练有素的工作人员,健康管理信息系统(HMIS),设备,和药物,在初级保健中心(PHCs)。这项研究评估了世卫组织一揽子计划中DM成分的可用性,以及这些PHC中的卫生工作者准备实施DM筛查,评估,和管理计划,以告知未来的采用和实施。
方法:这种横断面形成性评估采用了WHO服务可用性和就绪性评估(SARA)工具,以调查通过多阶段抽样选择的30个PHC,以便在阿布贾提供DM诊断和护理。尼日利亚,2021年8月至10月。对SARA工具进行了调整,以专注于DM服务,并根据具有可用DM护理服务的PHC比例计算可用性和就绪性指标分数,最低员工要求,诊断测试,设备,药物,和定义的SARA领域内的DM护理国家指南/协议。
结果:所有30个PHC报告至少有两名全职员工(中位数[四分位数间距]=5[4-9]),主要是社区卫生推广工作者(中位数[四分位数范围])=3[1-4]。最近至少有一名工作人员在11个PHC(36%)中接受了DM护理培训。该研究还报告了纸质HMIS的高可用性(100%),和使用血糖仪的DM筛查服务(87%),但是DM工作辅助工具的可用性很低(27%),治疗(23%),和国家指南/协议(0%)。
结论:对PHCs的形成性评估准备实施DM筛查,评估,和阿布贾的管理计划表明准备将DM护理整合到有关设备的PHCs中,纸质HMIS,和非医师卫生工作者的可用性。然而,需要制定战略来促进DM卫生劳动力培训,提供DM管理指南,并提供必需的DM药物。
BACKGROUND: Noncommunicable diseases (NCDs) are associated with high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of National policy, Nigeria has committed to implement the World Health Organization (WHO) Package of Essential Non-communicable Disease interventions for primary care. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems (HMIS), equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the DM component of the WHO package, and the readiness of the health workers in these PHCs to implement a DM screening, evaluation, and management program to inform future adoption and implementation.
METHODS: This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August and October 2021. The SARA tool was adapted to focus on DM services and the availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain.
RESULTS: All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] = 5 [4-9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1-4]. At least one staff member was recently trained in DM care in 11 PHCs (36%). The study also reported high availability of paper-based HMIS (100%), and DM screening services using a glucometer (87%), but low availability of DM job aids (27%), treatment (23%), and national guidelines/protocols (0%).
CONCLUSIONS: This formative assessment of PHCs\' readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs regarding equipment, paper-based HMIS, and nonphysician health workers\' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and supply essential DM medications.